Time is running out to get ACA health insurance; 8 things to know

John Murawski The News & Observer (Raleigh, N.C.) (TNS)

Saturday

Dec 8, 2018 at 12:01 AM

With just over a week left to enroll for federally-subsidized health insurance through the Affordable Care Act, a surge of people are expected to sign up for medical coverage that goes into effect Jan. 1.

Advocates for the program, also known as Obamacare, are making a final push to get people to sign up for health insurance for themselves and their families. The N.C. Navigator Consortium held an event in Raleigh on Thursday with Gov. Roy Cooper and his Secretary of Health and Human Services, Mandy Cohen, to help get the word out.

Total ACA enrollment in North Carolina is just under 185,000 as of Dec. 1, well below the nearly 520,000 who signed up last year for coverage. Even though most people are expected to buy health insurance closer to the Dec. 15 enrollment deadline, this year’s enrollment total is expected to fall short of last year’s.

Several changes mean that signing up for health insurance is different this time around.

Here are a few things to keep in mind when signing up

* There are no penalties in 2019 for not having health insurance.

That’s one reason fewer people are signing up this year, the fifth year of the Affordable Care Act, said Mark Van Arnam, co-director of the N.C. Navigator Consortium. In recent years, the penalties were not enforced, but 2019 will be the first time that the health insurance mandate, and penalties, will be off the books altogether.

* Short-term health plans will be available for the first time.

These plans — offered by UnitedHealthcare, Blue Cross subsidiary Mosaic Group and others — had been allowed for limited three-month enrollments, as a bridge during unemployment or to cover a short gap in health insurance coverage. But starting in January, anyone will be able to enroll in a short-term health plan for a full year, and they will also be able to renew their coverage, as long as the insurers will accept their applications. Short-term health plans are much cheaper than health insurance under the ACA because they don’t have to meet ACA standards. For example, they don’t have to cover all the conditions that ACA plans insure and they can turn down applicants with pre-existing conditions, so they don’t have to pay for costly medical care. These plans are expected to appeal to healthy, young people who rarely see a doctor and need cheap coverage for emergencies.

* There is a new health insurer in North Carolina.

Blue Cross and Blue Shield is offering ACA plans in all 100 counties of the state, just as in past years. Cigna is in five counties: Wake, Johnston, Orange, Chatham and Nash. But in 2019, a new player, Centene, will be offering a plan called Ambetter, in two counties: Wake and Durham. That means that Wake County residents will be in an unusual position of having a choice of three health insurers for ACA coverage. The rest of the Triangle will have two insurers, while most North Carolina residents will have just one option: Blue Cross.

* Your doctor may be out of network.

Insurance networks can change year to year, so check to see if your doctor is “in-network” on the plan that you like. If the doctor is not in the network, it will cost you a lot more to see him or her. You can try to find another doctor that’s in the network. Or you can pick another health plan that covers your doctor’s services.

On the flip side, some ACA policies are not changing in 2019

* Navigators are still available.

Trained in the small print of the Affordable Care Act, these volunteers and nonprofit employees offer free consultations on ACA plans and benefits. To set up an appointment throughout the state, call 855-733-3711 or go to ncnavigator.net. Another option for obtaining insurance information is an old-fashioned insurance agent or broker, if you can find one; many have dropped out of ACA work after their commissions were slashed or eliminated in recent years.

* You can still get financial assistance.

ACA plans continue to offer subsidies for people who are below 400 percent of the federal poverty level, and they offer additional financial aid for people below 250 percent of the federal poverty level. Gwen Vinson, an ACA navigator in Raleigh for the past five years, said that she has seen low-income people get health insurance for $2.15 a month, 60 cents a month and even zero cost a month, because subsidies pay most or all of the monthly premium.

* You can sign up after Dec. 15, but only under limited circumstances.

For example, you can sign up if you lost your health coverage at work, if you moved out of the area, if you moved from a shelter or from transitional housing, if you got married, if you had a baby or adopted a child, or if a household member moved out or died. But for most people, the only option to get health insurance outside the open enrollment period will be to find a short-term health plan and hope it meets your health needs.

* Remember your monthly premium is not the only cost of health insurance.

You will have to meet an annual deductible, which could be several thousand dollars, before your insurer pays your medical bills. And there will likely be co-payments for medical services that you’ll have to pay. For example, Elyse Rioux, a 29-year-old Raleigh resident who was at the Thursday event, signed up for a Blue Cross health plan that will cost her $15 a month in 2019, after federal subsidies. However, Rioux’s policy has a total out-of-pocket cost of $2,000 for a deductible and co-pays, so if Rioux had a major medical bill next year, she’d have to pay up to $2,180, and Blue Cross would pay the rest.

For more information about the ACA, go to the Kaiser Family Foundation’s page of frequently asked questions.

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